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Argus Announces Next Generation Pharmacy Claims Processing Solution
Date:11/28/2012

urces devoted to this effort have been focused on solving real-world customer issues as opposed to producing technologies in search of a business need, as sometimes happens when companies eschew listening to their customers," stated Mary Ellen Mitchell, COO, Excelsior Solutions, LLC, a pharmaceutical and healthcare consulting firm. "The fact that such material amounts of innovation have occurred without sacrificing the quality of the core service delivery to customers is a testimony to the technical sophistication of Argus."

RxNova™ provides Argus customers with a robust system designed to allow the user to control benefit development through an intuitive protocol that gives the user increased control of their benefit design and exposure to their data without the need for hard coding. This initiative includes a user interface with an intuitive rules-based architecture to engage with the software, delivering greater ease of use, and flexibility in customized benefit design.

To facilitate increased benefit complexities, enhancements to the benefit auditability include customized messaging and tagging options within the benefit rules structure. Embedded into this component is Benefit Validator™, documentation and analytics that provide a real-time accountability trail and audit feature that supports and augments evidence of coverage at the pharmacy-benefit level. Enhancements to claim inquiry include detailed data enrichment that provides a decision flow of the adjudicated claim, including each of the decision points or rules utilized during the adjudication process. The increased visibility into these decision points includes a historical audit perspective that identifies messages associated with the claim as it was adjudicated, such as error exceptions and overrides. Historically, several hours could be spent on pharmacy claim research to determine why and how a particular claim derived its resultant financial and clinical outcome; RxNova&
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SOURCE Argus Health Systems, Inc.
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